The "Cut-to-the-Light" Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique.

Objective: To describe our new endoscopic approach in treating iatrogenic ureteral stenosis using the "cut-to-The-light" technique. Methods: Case of a 54 year-old female patient who underwent a right percutaneous nephrolithotomy to treat a staghorn calculus with two subsequent complimentary ureteroscopies complicated by a severe proximal ureteral obstruction. An antegrade flexible uretereroscope and a retrograde rigid ureteroscope were used to locate the stenosis. With the aid of a 365-µm Ho: YAG laser fiber (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope and a through-and-through guidewire was then placed, securing the ureter. Ureteral dilatation was then performed followed by a full thickness incision of the ureteral stenosis. A single 8Fr, 28 cm double J ureteral stent was finally placed after stone fragmentation. Results: The operating time was 200 mins. No blood loss. No fever or signs of UTI were seen shortly after the operation. The Foley catheter was successfully removed at day one post-op. The hospital stay was short of only 2 days. Conclusion: The "cut-to-the-light" technique is a new application in the arsenal of ureteral stricture treatment that has been scarcely described in the literature before. The use of this method seems to offer excellent outcomes thus demonstrating the importance of this minimally invasive technique as an alternative to conventional invasive methods used. We believe that studies with larger samples and longer follow up are needed in order to fully determine the benefits of this method and to assess and reveal its suitable application and its drawbacks.

Rare paraneoplastic syndrome of prostatic cancer: limbic encephalitis: a case report.

INTRODUCTION: Limbic encephalitis is an autoimmune neurologic disorder, often of paraneoplastic origin, that seldom complicates prostatic tumors. The nonspecificity of symptoms makes the diagnosis sometimes difficult to establish. Prognosis is essentially determined by comorbidities and sensorineural and cognitive sequelae. CLINICAL CASE: A 66-year-old Caucasian patient known to have prostatic small-cell neuroendocrine adenocarcinoma under hormonal therapy developed complex partial epileptic seizures associated with rapidly aggravating severe memory impairment. The tripod of autoimmune limbic encephalitis diagnosis was based on the clinical aspect of brain's functional deterioration, electroencephalography aspect, and γ-aminobutyric acid type B anti-receptor antibody positivity. Clinical, diagnostic, and therapeutic management as well as evolutionary risks were further analyzed. CONCLUSION: Limbic encephalitis is an extremely rare presentation of neurologic paraneoplastic syndromes. A better knowledge of this entity would help better manage diagnostic and therapeutic difficulties and reduce the risk of possible sequelae.

Large-cell neuroendocrine tumor of the prostate: a case report and review of the literature.

BACKGROUND: Primitive neuroendocrine prostate neoplasms are rarely reported. This entity comprises carcinoïd tumors and poorly differentiated neuroendocrine tumors, mainly those of the small-cell type. Large-cell-type primitive tumors are exceptional, and only nine cases are reported in the literature. Similar to neuroendocrine tumors of the prostate, large-cell-type primitive tumors may be observed in the context of conventional adenocarcinoma during androgen deprivation therapy or as prostatic metastasis of a distant neuroendocrine tumor, mainly pulmonary neoplasms. CASE PRESENTATION: We report a Caucasian case of a mixed prostatic carcinoma, with the largest component being the large-cell neuroendocine carcinoma, in a patient who underwent a total prostatectomy for a localized cancer. Diagnostic, histological, therapeutic and evolutive aspects are reported and discussed. CONCLUSIONS: Large-cell primitive prostate neuroendocrine carcinoma is a rare but aggressive histological entity, which can be associated or not with an adenocarcinomatous component. Mixed forms have a better outcome, mainly when diagnosed at an early stage.

Corrigendum to "Testicular plasmocytoma as an unusual late relapse of multiple myeloma" [Urol Case Rep 31 (2020) 101181].

[This corrects the article DOI: 10.1016/j.eucr.2020.101181.].

Alternative surgical approach for inflatable penile prosthesis removal.

BACKGROUND: The Inflatable penile prostheses (IPP) are used as definitive treatment for severe erectile dysfunction. Removal of an IPP can be challenging, especially for the non-andrologists and junior urologists. The classic penoscrotal incision for explanation can disrupt anatomy, which increases the risk of complications and makes future re-implantation difficult. This article aims to describe a simple surgical method for the removal of IPP, which avoids the penoscrotal incision and reduces the risk of urethral damage and additional fibrosis. MATERIAL AND METHODS: Between November 2015 and February 2019, 15 patients underwent IPP removal using the same technique. Multiple incisions were performed directly over each component of the IPP for their removal. Four incisions of 2 cm each were made at the following sites: one incision on both sides of the ventral base of the penis, one inguinal incision, and one scrotal incision. Each incision provides direct access to one component of the IPP (cylinders, reservoir, and pump). RESULTS: The mean duration of the surgery was 41 min (between 35 and 48 min). All procedures were completed successfully with a smooth course. None of the patients had any residual component of the IPP at the time of surgery. Neither complications (urethral or intestinal injury) nor excessive bleeding (> 100 mL) were documented in all patients. CONCLUSION: Our approach provides direct exposure of all components of the IPP. It reduces the risk of urethral iatrogenic injury and the local fibrosis (which is greater with the penoscrotal incision) that may impair future reinsertion of IPP. It is simple, safe, reproducible and easy to be performed by junior or unexperienced urologists in urgent cases. CONTEXTE: Les implants péniens hydrauliques (IPH) constituent le traitement définitif des dysfonctions érectiles. Le retrait de ces prothèses peut être difficile, surtout pour les jeunes urologues. L'incision classique péno-scrotale est. peu anatomique. Elle est. associée à un risque de plaies urétrales et de fibrose pouvant limiter l'insertion ultérieure de nouvelles prothèses. Nous présentons dans cet article une méthode alternative simple pour le retrait des IPH qui permet d'éviter l'incision péno-scrotale et les risques qui s'y associent. MATÉRIEL ET MÉTHODES: Entre novembre 2015 et février 2019, 15 patients ont été opérés pour extraction d'IPH infectés, en utilisant la même technique chirurgicale. Une incision de 2 cm est. réalisée en face de chaque élément de l'IPH pour permettre son extraction: une incision scrotale, une autre inguinale et une de chaque côté de la base ventrale du pénis. RÉSULTATS: La durée moyenne de l'intervention était de 41 min (entre 35 et 48 min). Toutes les interventions ont été bien tolérées. Les éléments des IPH ont été retirés sans fragments résiduels. Aucune complication n'a été notée. CONCLUSION: L'approche décrite permet l'exposition directe des composantes des IPH. Elle permet la réduction du risque des lésions urétrales iatrogène et de fibrose ultérieure. Celle-ci est. plus fréquente avec l'incision péno-scrotale et peut limiter l'éventuelle insertion de nouveaux implants. Notre technique est. reproductible et simple pour être appliquée sans danger par les jeunes urologues peu expérimentés.

Testicular plasmocytoma as an unsual late relapse of multiple myeloma.

Among extramedullary manifestations of multiple myeloma, testicular localization is exceptional. A scrotal mass in this context poses diagnostic and therapeutic challenges given the aesthetic, psychological and reproductive impact of surgery. Authors report a case of testicular plasmocytoma seven years after remission from multiple myeloma. The treatment consisted of left inguinal orchidectomy. Diagnosis needed the recourse to immunohistochemistry. Diagnostic modalities, therapeutic options and evolutive eventualities will be discussed. Extra-medullar localization is exceptionally reported in extramedullary multiple melanoma. Management depends on the concomitant or distant character of hemopathy diagnosis and the disease evolutive history.

Diagnosis and laparoscopic management of retrocaval ureter: A review of the literature and our case series.

OBJECTIVES: To expose the diagnosis and the different laparoscopic approaches for the surgical management of patients with retrocaval ureter (RCU) and to share our experience on two cases. METHODS: Updated literature review on Pubmed and debating personal experiences including ours (double j stent insertion before the surgery, use of 4 trocards, transperitoneal approach, pyelopyelostomy for the anastomosis…), concerning the laparoscopic treatment of the RCU. RESULTS: Laparoscopic treatment of RCU is a recommended management for many reasons: less blood loss during the surgery, a shorter hospital stay, less postoperative pain and superior esthetic results with excellent functional results. All of these findings were also a part of our experience on the two reported cases: operative time was 210 and 180 min with no significant bleeding, hospital stay was 48 h post operatively for both patients that were symptom free with no renal dilation after 2 years of close follow up. The main cause of the increased operating time is the intracorporeal anastomosis of the ureter which remains the main limiting factor of the laparoscopic surgery. CONCLUSIONS: The literature review has clearly shown the advantages of minimally invasive techniques for the treatment of retrocaval ureter. Pure laparoscopic treatment (as in our two cases), seems feasible and technically reliable, and should be the standard surgical option for the treatment of RCU.

Juxta-adrenal schwannoma presenting as a giant adrenal tumor: A case report and a literature review.

INTRODUCTION: Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. Juxta-adrenal schwannomas may be misdiagnosed with giant adrenal tumors. This article reports the case of a RS that presented as an asymptomatic adrenal mass in a 50 Y.O female. PRESENTATION OF CASE: An abdominal ultrasound of our asymptomatic patient showed right adrenal lesion of 9 cm of diameter. Endocrinological evaluation was negative. The patient was considered to have a non-secreting right adrenal mass confirmed by adrenal scan. We began a right laparoscopic trans peritoneal adrenalectomy, but when we discovered intra operatively that the wall of the IVC and the renal vein were very adherent to the mass which had a lot of small vessels that were bleeding, we converted to open surgery that allowed us to remove the mass safely. The operative time was 200 min, the blood loss was 850 cc and the patient was discharged uneventfully on the sixth day after surgery. DISCUSSION: Although we thought that we removed a huge adrenal tumor from the retroperitoneum of our patient, the pathological exam revealed a RS that comprises the adrenal gland which was normal. Preoperative establishment of diagnosis is difficult in case of RS that can be misdiagnosed, especially when they stick to other structures (the adrenal in our case). CONCLUSION: Complete surgical resection is the treatment of choice for RS and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirms the diagnosis that can be easily missed preoperatively.